Healthcare Provider Details

I. General information

NPI: 1649596255
Provider Name (Legal Business Name): JULIA GRISELDA HERNANDEZ CA LM 142, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VALLEY RD
FAIRFAX CA
94930-1914
US

IV. Provider business mailing address

15 VALLEY RD
FAIRFAX CA
94930-1914
US

V. Phone/Fax

Practice location:
  • Phone: 415-307-7251
  • Fax: 415-453-8223
Mailing address:
  • Phone: 415-307-7251
  • Fax: 415-453-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCA LM 142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: